They should also offer better deductibles and co-pay to those of us who look after our health. I'm not obese. I eat healthy and don't smoke. I shouldn't have to support the people that do.

#2 is unnecessary. Insurance companies are currently being forced NOT to compete across sate lines. Remove the block and they'll do it voluntarily.

Kyrie, if they did that it be racist, or classist, or sexist, and therefore a violation of someones civil rights. Only in communism where we enforce an equality of out come are thing "fair"

Its unfair to expect people to be responsible for themselves

Already covered here...

Pretty good 4, I'd add a 5th. Reform lawsuits.

Regardless of a Dr being at fault or not, few juries are so stone hearted to not give a blank check to a crying "mother" if anything goes wrong during birth.
When we teach Drs to run away if they see a traffic accident, for fear of lawsuits, we have a serious problem.

More support for #1 here - As individuals age we (typically) have more resources to pay for non-catastrophic procedures and treatments. Why would you want to require someone to have a policy to cover what they can pay for?

We manage our auto and homeowners policies through higher deductibles. It would make sense to do the same with our health premiums.

Actually, Joe J, I write in "Good Manners For Nice People Who Sometimes Say F*ck" about the power of apologies by doctors for bringing down the cost of lawsuits, keeping cases out of court, and sometimes getting patients and their families to drop them altogether.

The Louisville VA hospital saw a SUBSTANTIAL drop in the money they paid out after they began allowing doctors to admit wrongdoing and apologize.

The Louisville VA hospital saw a SUBSTANTIAL drop in the money they paid out after they began allowing doctors to admit wrongdoing and apologize.

Posted by: Amy Alkon at July 6, 2014 8:36 AM

I wish I could agree. But in states where liability tips in favor of the plaintiffs lawyers, any admission of wrong doing or a mistake will get you dropped by your insurance companies at best, sued out of existence at worst.

The system is structured that way.

Also

The VA hospital is a government entity. They cant be sued unless they agree to let themselves be sued. They doctors are government employees. Big difference.

When medicine is completely socialized doctors and hospitals wont be on the hook for anything, no matter how negligent.
And the only thing the patient will get is an apology.

Yes, in order to sue a VA hospital, you must file under the Federal Tort Claims Act, and the government's liability is much more limited than a private hospital's would be.

The problem is different states have different regulations... so a place that requires insurance to cover more procedures will be more expensive. I'm not sure, does it mean that companies based in those states need to follow those regulations, or companies doing business? If they said all companies could compete everywhere, would Insurance form LaxStateX have to provide the things in StrictStateY even if not based there?

Obama Care is designed to fail from the start and Obama knows it so he can then have USA on a one system pay plan that will bring the USA down to a 3rd world country. Obama Care will ruin our America. By the way, go see the documentary: "America, what would we do without her?" It's a real eye opener and liberals will love it....well, the first 20 minutes anyway...many myths debunked near the end of the documentary.

Had an interesting conversation with an older relative. According to him (and he loves this stuff, so while I'm not terribly informed myself, I feel fairly comfortable saying it's likely true), while patents on drugs last a good while, they are required to be made within a year of the original production of such drug. Since it takes a minimum of three HUMAN clinical trials before the FDA will approve anything, they basically get 5-7 years before generics can be made. This is great in terms of generics being cost effective, but if they have to cover the cost of all the drugs that didn't pan out and a decade or so of research with selling a new drug for a few years, that drug is going to be more expensive than if they had longer.

Of course, the counter argument is that there would be nothing to keep them from having equally high prices for longer, and that is true. However, if we are talking just cost covering at a minimum, this is clearly not making brand names any cheaper. If it won't make money, why would people invest their time/money/energy trying to do it? They have to pay the scientists, fill out federal forms (like doing tax forms from hell), recruit participants, etc.

@Miss Alkon: And I'll add number 4: Untie healthcare from the workplace.

I'm a little curious as to why this would reduce costs. I think self-employed people can deduct the cost of their medical plans from their income, if I understand the fifth paragraph of this IRS topic correctly.

I'm a little curious as to why this would reduce costs. -- Old RPM Daddy at July 6, 2014 12:34 PM

It wouldn't necessarily reduce costs, but it would allow untie the employee from an employer because the employee wouldn't be dependent n their employer for insurance.

Over time it would probably lower premiums as the consumer can and would probably say I only want t be covered for this and "Why does this coverage cost so much?"

so number one is impossible...

How do you pay for all this shiite? Healthy people who never use the service, finance people who do. It's not rocket science.

Catastrophic is a bet that the company makes that you will never use it, while you give them a few bucks just in case.

That bet ONLY works if the insurance company can make some assumptions, and rules... one of which is not insuring people likely to get sick, or pregnant. Becasue that is a knowable fixed cost, and it ISN'T catastrophic.

All that works in a marketplace. If your catastrophic coverage in a market becoems a catastrophy, due to guessing the risk wrong, the company stops covering, and so forth.

Now let's get the federal governemnt involved. They tend to ensure that their OWN rules are followed, and the OUTCOME is guarunteed.
Like suddenly: "I have cancer, NOW I want insurance."

Government spreads the cost of that over the populace, and it gets managed. The only downside is that the person in question never planned or paid for this, in any way.

We accept that if it's a rare occurance, and essentially 'bad luck'. But if you reward behavior, you get more, and suddenly, Why should anybody pay into that system, when it has to cover them regardless?

The risk is low, since the governement will pick up the tab... The RISK to the taxpayer is extreme, though. They are no longer paying for bad luck.

Interestingly, this is another step in the direction of single payer, because if critical mass is reached, the governement will simply pay for it all out of taxes, and nobody has a choice.
Each little step seems logical, but you end up someplace you hadn't planned... or at least you didn't want to go to, but others did.

Another reason to untie it is, work can change it at whim. Current company shops around every 12 months, they don't always change but I don't have much input. Every time it switches, have to learn a new system.

"I'm a little curious as to why this would reduce costs."

Wow. You think your company's time administering the plan is free?

And evidently nobody can follow that link; if you do not concentrate on paying doctors and labs, all the "health care" in the world is not going to get you into a doctor's office!

You already have deductibles and exceptions to make sure you do not get service despite paying for it. Why in the world do you think that paying for something you do not receive is a good idea?

Is it me, or is anyone ELSE picturing Amy's Alien Love Child ???? (evil grin)

I got laid off in February and am now paying out the ass to keep Kaiser insurance. My husband had a who cares attitude about it and said we could get cheaper insurance elsewhere and pick new doctors. Okay fine, but I have a blood clotting disorder and it took forever to find a doctor that understood and was able to manage it well for me. I went through probably 20 doctors and no one had even heard of it let alone how to manage it. I also love my kids' pediatrician and she specialized in preemies, which was just what we needed (all my kids have been preemies). I don't want to have to try to start over somewhere else and build a new relationship with doctors and have them try to learn our histories. I did briefly consider it, but the few doctors that fit the necessary criteria in my area did not accept any of the individual insurances or were not accepting new patients. The only one that was, was someone I'd seen in the past that was a real prick and thought the best way to manage my blood clotting disorder was to do absolutely nothing until I actually suffered from blood clots or a stroke (this approach led to a lot of associated problems for me). A good relationship with your doctors is very important for your care.

I've always been able to deduct my costs of health insurance when I worked as an independent contractor in the past. There were some situations where you couldn't but it didn't apply to me.

Again, imagine a job that takes a doctor like this away from me by switching plans or imagine that being done to somebody who is suffering with a pretty awful disease.

Posted by: Amy Alkon at July 6, 2014 5:02 PM

Take all the health insurance premiums you pay. Divide by the number of visits you think you need to keep you functioning, and then ask him what his cash price would be.

No one is taking a doctor away from you by refusing to sell you an insurance plan that he accepts.

While I understand that Kaiser is an HMO, and this doctor has a contract with them, what we really need is to uncouple doctors from insurance plans rather than the workplace from insurance plans.

Changes can happen anyway. My one dentist changed from Prime to Preferred network...my co pay went from $5 to $25 and my cover went from 80% to 60%. Sucked.

And I have seen employer supplied coverage change such that a co-worker's doctor was no longer in the plan.

Of course Amy Individual's insurance could also have her options changed. Ins company: Oh Amy...she is awfully expense...maybe we won't renew...or her rates will go way up.

"Another reason to untie it is, work can change it at whim. "

Yep. Last year my company changed to a significantly worse plan. Our out-of-pocket expenses went up substantially (as in thousands).

Eventually the plans are going to have to be split into two parts. One part will be a true insurance policy for catastrophic events. The other part will be a sort of investment account to cover expenses that will be exepcted eventually. After all, if you live long enough, you will need expensive medical care at some point. Of course, in order to make this work, your plan has to belong to you. If you have to start over every time you change jobs, it won't work. That's why uncoupling from employment is an essential step.

(However, that does leave people of my age cohort screwed. I spent my young, healthy years paying into a system that I didn't use in order to subsidize older, sicker people. Now that I'm getting older and sicker, it's clear that there won't be anyone to subsidize me.)

"While I understand that Kaiser is an HMO, and this doctor has a contract with them, what we really need is to uncouple doctors from insurance plans rather than the workplace from insurance plans."

Again, this covers that. Obamacare is not going to.

Isab has a great point. It is probably far more important to untie insurance from providers...that is where I have seen the real problem.

My grandmother had that problem... need a particular procedure. One local hospital could do it...but they aren't are affiliated so she needs to go one that is 1.5 hours away if the insurance company is going to pay.

No, Isab is wrong. If your insurance was not tied to your employer you could change to keep the network you like. You could ask the doctor which insurances they accept. You can ask today if they take cash, but most won't. As long as the company decides you don't have control.

Equally important, most people don't know how much the company is paying for their insurance. That is a benefit that they could receive in cash and I think most would given the choice. There is a graph floating all over the internet which shows how productivity and income were correlated till ~1970, at which point pay no longer keeps up. Well guess what, the difference is benefits. And health insurance is a major part of that.